Healthcare Provider Details

I. General information

NPI: 1053742098
Provider Name (Legal Business Name): MICHELLE SHEEHAN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2013
Last Update Date: 06/18/2024
Certification Date: 01/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3640 MAIN ST STE 208
SPRINGFIELD MA
01107-1192
US

IV. Provider business mailing address

3640 MAIN ST STE 208
SPRINGFIELD MA
01107-1192
US

V. Phone/Fax

Practice location:
  • Phone: 413-253-2767
  • Fax: 413-253-9767
Mailing address:
  • Phone: 413-253-2767
  • Fax: 413-253-9767

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2290040
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: